Subscribe To

Thursday, May 30, 2019

Retrospective #104: It’s Not Feckless to Be Fickle

I have mused a few times about how most doctors and
dietitians, especially established practitioners, are in a bind. The younger
ones can still have an epiphany without ruining their practices. It must be a
rude awakening when they do, but they can do it with integrity if they are
truth seekers. The older ones, as I see it, have three problems:

1) The mantra when they were schooled in medicine (doctors)
and nutrition (dietitians) – never to be cross-fertilized – was the coda of the
day: the diet-heart hypothesis (the saturated fat/cholesterol/heart disease hypothesis)
from the now widely discredited work of Ancel Keyes. When he joined the Board
of the American Heart Association in 1961,, and made the cover of Time Magazine, the “die was cast.”
Everybody read Time in those days.
Now, it’s just a pamphlet! But the medium spread the message. To this day, the
health establishment trumpets it.

2) The specialties in medicine are governed by medical
associations that set “Standards of Practice” that are in turn adopted by
Medicare and then by private insurance companies. In some ways it makes medical
care simpler, quicker and certainly less risky. The older clinician gives you and
the standard exam, the standard reimbursable tests using the standard medical
codes, for which he gets paid, and the standard treatment: a script for pill(s)
and advice to lose weight (“eat a balanced diet”) and “move more” (exercise). Then,
you’re outta there. Next patient!

3) The problem is, how can a doctor deviate from this? Will
he get paid for that non-standard test? How can a doctor change when he has an
open mind and sees something that works after so many years of the exact
opposite? Admit that what he has been prescribing for many years, doesn’t work
that well? That what he has been telling you all these years is wrong? That it
is exactly backwards? That the diet-heart hypothesis was not evidence-based,
just bad science? Many doctors and scientists have said so, but what will the
patient think if his doctor,
his trusted personal health advisor, does a complete about face? How can I still
be confident? Is he a quack?

Many doctors and nutrition scientists are saying this now, but to be fair, not for the same
indications. My doctor, who was a board-certified internist and cardiologist,
suggested that I try Atkins Induction – off label, as it were – to lose weight. He had just read
Gary Taubes’s July 2002 New York Times
Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie.” He had tried
it himself, had lost 17 pounds in a little over a month (with no ill effects on
his cholesterol panel), and suggested I try it. Ever cautious, though, he did monitor
me monthly for a year.

Anyway, most doctors would have a hard time doing what my
doctor did, even if they believed in it. But you, their patient, are not in the bind that they are in. You can be “fickle without
being feckless.” You’ve got
nothing but your improved health at stake (LOL). Not that that’s
inconsequential. You, the patient, can
change what you eat.

Okay, you don’t have to do “the full Monty” to start with, or
ever, for that matter. You could start with just a low carb, moderate protein
and high fat diet. That’s still a very big improvement over the way you are
probably eating now. The Recommended Daily Allowance (RDA) of the Standard
American Diet (SAD), the one on the Nutrition Fact Panel on packaged (boxed and
bagged) foods is 60% carbohydrate, 10% protein and 30% fat. You could do 40%
carb, 30% fat and 30% protein. That would be a reduction from 300 grams of
carbs to 200. Or, you could work your way down to 20% carbs (100 grams of carbs/day
on a 2,000kcal/day diet).

Then, after you adjust (and lose weight and lower your
triglycerides and raise your HDL), you could try 20 grams per meal, with no
snacks (you won’t have any cravings – in fact, you won’t even be hungry). Or, you could do Bernstein
(6-12-12 = 30/day), or Atkins Induction (20g/day) or my current Way of Eating.
I do 15g of carbs/day. I now eat 5 grams of carbs at breakfast, zero at lunch,
and 10 at supper, unless I have a glass or two of wine, which I often do now.
That bumps me up to between 25 and 30 grams of carbohydrate a day. And I’m still
ketogenic.

The point is: You
are not constrained by your profession. You
will not be feckless if you change the way you eat. You can be fickle. You
can try eating lower carb, or low carb, or very
low carb the way I do. It’s okay to do what works for you. It’s your
health. It’s your life. And
now, it’s your time to decide.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.